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2nd most common cause of disability among adults
Most common arthritis
Progressive deterioration & loss of cartiliage in 1 or more joints
What are the manifestations of osteoarthritis?
- 1. Chronic joint pain & stiffness
- 2. Joint is often enlarged b/c of bony hypertrophy
- 3. Nodes may also be present (on both hands)
- 4. Joint effusion common w/ knee involvement
- 5. Pain cycle discourages movement which may result in contractures
- 6. Muscle atrophy
- 7. Further pain
What are the early signs of osteoarthritis?
Hint: think ostearthritis = PAIN CONTROL
Pain diminishes after rest & intensifies after activity
What tests do Dr. orders for osteoarthritis?
- - X-rays: determine structural joint change
- - CT Scan - for vertebral involvement
What are some nursing interventions for osteoarthritis?
REMEMBER: PAIN CONTROL
- 1. analgesics
- 2. rest
- 3. positioning
- 4. thermal (HEAT) modalities - heat instead of cold to decrease muscle tension
- 5. wt control (well balanced diet & gradual weight loss) - b/c weight will put burden on your knees & hips
- 6. integrative therapies (acupuncture, herbal, chiro, somatic experiences)
1. What are some surgical options for osteoarthritis?
2. What are some contraindications
1. total joint arthroplasty (TJA) or TOTAL JOINT REPLACEMENT.
2. infxn, advanced osteoporosis (may cause bone shattering), & severe inflammation (post-op may increase & cause prosthetic failure)
Knee replacement last about 10-15 years.. so you might want to wait til later years to get this
1. What is a potential compliation for total hip arthroplasty?
2. What drug(s) are usually used to prevent this complication
- 1. Potential for infection
- 2. Prophylactic IV abx pre-op
What is the most commonly replaced joint surgery?
THA - Total Hip arthroplasty
Give some nursing interventions for each of the following post-op complications of THA.
1) subluxation (partial) or total dislocation
2) venous thromboembolism
5) neurovascular compromise
- 1)keep legs abducted, prevent hip flexion beyond 90 degrees. (Signs of dislocation - pain, rotation, extremity shortening), use raised toilet seats, straight back chairs, reclining W/C
- 2)Thigh high TEDs, SCDs, foot pumps; anticoagulants, exercise & OOB POD #1
- 3) most likely from contamination during surgery (older adults may not have a fever but altered mental status) - watch for s&s of infxn
- 4) monitor dressing & drains, & H/H
- 5) compares operative & non operative leg
What is one huge NURSING INTERVENTION for pt. after HIP replacement surgery?
- LEGS can never cross median!
- Keep legs abductive - use pillows
- Don't want them to bend down & tie their shoes
- Sitting up straight or reclined is OK.
- Don't want to decrease 90 degree angle by by bending over.
What are some important NURSING INTERVENTIONS after a knee replacement surgery?
What is the goal for discharge?
- 1. CONTINUOUS PASSIVE MOTION - keeps in motion & prevent scar tissue
- 2. Knee maintained in a neutral position & not rotated internally or externally
Goal for D/C - walk independently with a cane or walker & close to 90 degree flexion in affected knee.
Osteoporosis is a silent occurence, but what test can diagnose this dz & what does it measure?
What are some S&S of fracture
Usually when you break a bone (fracture) you'll know that you might have osteoporosis.
DEXA - measures BMD
S&S of fractures. Back pain accompanied by tenderness & voluntary spinal movement restriction
1.What is a sign that suggests a compression vertebral fracture?
2. Who is at risk of compression fracture?
- 1. Voluntary spinal movement restriction (i.e: can't bend over to do something). Back pain accompanied by tenderness
- 2. Postmenopausal women
How is compression fracture related to osteoporosis?
Osteoporosis - bone mass diminishes --> bones fracture easily
What is an exercise to teach pt. to prevent osteoporosis?
weight bearing exercise
What medication causes bone loss?
What's in your body that prevents bone loss?
hint: in women
What are the most common osteoporotic fracture?
Wrist & hip
What are some treatments for compression fracture?
- 1. Bed rest
- 2. Analgesics
- 3. PT
- 4. Vertebroplasty & kyphoplasty
What are some risk factors for osteoporosis (11)
- 1. low calcium intake
- 2. tobacco use
- 3. eating disorders
- 4. sedentary lifestyle
- 5. excessive alcohol consumption
- 6. corticosteroid medication
- 7. Women
- 8. Old
- 9. Asian or white
- 10. small body frames
- 11. hyperthyroidism
What are quadriceps setting exercise? What does it do? What specific condition would you imply this exercise?
When you have your cliient straightens the leg & pushes the knee against the bed
It strengthens, reduces swelling, & prevents clot
Usually done after knee replacement surgery or surgery for meniscus injury
What test is done to detect meniscus tear? is it definite?
Mc Murray test. not definite
What test will support rheumatoid arthritis?
Arthrocentesis: analyze fluid or inflammtory cells & immune complexes, including RF
What is lymphatic metastasis?
Lymphatic spread - sites that are rich in lymphatics have earlier metastatic spread (breast, testicular)
Unexplained weightloss would be a redflag for what?
Primary vs. Secondary prevention (i.e: P for prevent, S for screening)
3. Skin inspection
5. Smoking cessation class
- 1. P
- 2. S
- 3. P & S
- 4. S
- 5. P
- 6. S
What is a HUGE side effect of cancer treatments (esp w/ chemotherapy - systemic effects)?
*hint: impaired immune system & impaired hematopoietic function
Pantocytopenia (impaired hematopoietic function)
List all interventions for neutropenic precautions
- 1. Restrict visitors
- 2. No fresh fruits, uncooked meat, vegetables, potted plants
- 3. Strict handwashing
- 4. No children around
- 5. Watch for S&S of infxn
- 6. Low bacteria diet
The nurse asks the following questions in an oncology assessment:
*appetite, taste, difficulty eating, swallowing, indigestion, bowel elimination.
What body system is she assessing & why?
She's assessing for altered structure & function of GI d/t obstruct or compress of tumor-- reducing ability to absorb nutrients or eliminate wastes.
What are some complications that bone metastases can cause?
*hints: complications that can reduce mobility. Also think spinal cord
- 1. fractures
- 2. spinal cord compression
- 3. hypercalcemia (can have cardiac effect)
- 4. sensory changes - spinal cord damaged by tumor pressure or if nerves are compressed
- 5. Pain
What are some N.I for bone cancer?
- 1. PT/OT
- 2. Analgesics
- 3. Limit activity
- 4. Monitor Ca level
- 5. Warn about cold & heat w/ sensory impairment
Which cancer rx has a prophylaxis purpose?
Choices: surgery, radiation, chemo, hormonal manipuation, immunotherapy, gene therapy, targeted therapy
This cancer rx debulks the tumor by decreasing the # of cancer cells to increase the chances that other therapies can be successful
What are the purposes for surgery as cancer rx? (6)
- 1. prophylaxis - remove benign
- 2. diagnosis/biopsy
- 3. cure- remove completely
- 4. control - debulks
- 5. palliation - relieve pain, trouble swallowing
- 6. reconstructive - increases function (breast reconstruction, revision of scars)
What is the purpose of radiation as a cancer rx?
DESTROY CANCER CELLS w/ minimal exposure of normal cells to the damaging actions of radiation. Cells die or unable to divide
What is brachytherapy?
hint: one way of radiation therapy
- * Short or close therapy. Uses radioactive isotopes
- * radiation source comes into direct & continuous contact. XRT source is within patient
- * Provides high dose of radiation in tumor tissues & limited dose in surrounding normal tissues
- *Patient emits XRT for a period of time & is a hazard to others
What are some concernts that nurses should address to pts receiving radiation?
- * Anxiety
- * Skin care - hot water, soap, gentle (YOUR SKIN IS DRY FROM XRT)
- * Reproductive
What is the purpose of chemotherapy?
- *Cure & increase survival time
- >>> damages DNA & interferes w/ cell division
- *Has systemic effect: useful at killing metastatic cancer cells
1.When chemo is given, any excrement within 48 hours is considered ________
2.When chemo patient comes in the room, you wear gown & mask for what purpose?
2. to protect urself from the toxicity of chemo
What are the tumors that divide quickly? (usually treated w/ chemo)
hint: usually they're the most sensitive to external radiation as well
- * Skin
- * Hair
- * Intestinal tissues
- * Spermatocytes
- * Blood forming cells (bone marrow cells)
What cancer rx is given on a regular basis & are timed to maximize cancer cell kill & minimize damage to normal cells (q 3-4 wekks for 6-12x)
If you're patient is experiencing pantocytopenia (i.e: bleeding, fever, fatigue, SOB..etc.), what interventions would you expect to be implemented for this CHEMO pt.?
STOP CHEMO RX! wait until they can tolerate it again.
What is the usual route for chemo administration?
Your pt. was recently diagnosed w/ metastasized cancer. What cancer rx is expected for this pt.?
Chemo. B/c it has a systemic affect to kill all metastatic cells
What are the side effects of chemo therapy? Also list N.I
- 1. alopecia - tell pt it'll regrow 1 month after chemo
- 2. n/v - give antiemetic meds before hands, watch for dehydration & electrolyte imbalances
- 3. mucositis (open sores on mucous membranes) -oral hygiene, avoid alcohol based mouthwashes, swish & spit w/ local anesthetic, appetite
- 4. skin changes, anxiety, sleep disturbances, altered bowel elimination
- 5. LIFE THREATENING: BONE MARROW SUPPRESSION (anemia & thrombocytopenia) : reduce risk of infections, stimulate bone marrow production of immune system cells, biologic response modifiers (neucogen, ecogen shots)
1. What are the usual causes of DIC (Disseminated Intravascular Coagulation)?
2. What is DIC?
1. Sepsis. Triggered by cancer
2. Release of thrombin or thromboplastin from cancer cells, abnormal extensive clotting occurs thru out the small blood vessels, using up all clotting factors & platelets --> bleeding
1.How do you prevent sepsis?
2.How do you prevent DIC?
1. HYGIENE! ABX! i.e: simple UTI can cause sepsis
2. Prevent sepsis, prevent DIC
1. Explain how cancer causes SIADH?
2. What is the rx for SIADH?
1. Some tumors can stimulate the brain to make & secrete ADH, water is reabsorbed to excess by the kidney & put into systemic circulation leading to HYPONATREMIA
2. RX: restrict water & increase Na
1. Secondary (palliative) bone cancers usually are...
2. What are bone seeking cancers?
1. metastatic cancers d/t previous xrt!
2. Prostate, breast, kidney, thyroid, lung (PBKTL - pack Burger King to lunch)
Large #s of tumor cells are destroyed rapidly, HOWEVER, their intracellular contents (K & purines) are released into the bloodstream (hyperK & acute renal faiulre d/t uric acid build up).
Rx for this?
Tumor Lysis Syndrome
Rx: hydration to dilute K & increase GFR to get rid of uric acid
Small breasted women w augmentation -- is BSE be easily performed?
YES! b/c it prosthesis is behind breast tissue
What are the barriers for mammography?
- 1. Cost
- 2. Fear of XRT
- 3. Fear of results - benign breast tissues don't make you a higher risk.
- 4. Concern about pain
- 5. Knowledge - family hx - only 5% of breast cancers are hereditary
Simple mastectomy are breast tissue & nipple
Modified radical removes affected lymph nodes. Can you take BP on that arm?
T or F
Radiation damage to normal tissue starts the inflammatory process that causes tissue fibrosis & scarring (i.e: uterine radiation may affect the colon years later)
What are the S&S of anemia? (10)
- 1. SOB
- 2. Weakness, fatigue, dizziness, pallor
- 3. GI symptoms
- 4. Jaundice
- 5. Red, sore tongue
- 6. Hypotension
- 7. Tachycardia
- 8. Pica
- 9. Depression
- 10. Dementia
What are the complications of anemia?
- 1. Angina/HF/MI (not enough O2 & blood to heart)
- 2. Paresthesias
- 3. Confusion
- 4. Injuries (feel dizzy & fall)
Based on the complications of anemia: heart dz, paresthesias, confusion, injuries... what are the interventions for anemia?
- 1. Manage fatigue
- 2. Maintain optimal tissue perfusion
- 3. Encourage adequate nutrition
- 4. Monitor for potential complications
How do you confirm aplastic anemia ?
Bone marrow aspiration
What induce RBC sickling? (7)
- 1. Hypoxia
- 2. Dehydration
- 3. Cold
- 4. Acidosis
- 5. Anesthesia
- 6. Infxn
- 7. Exercise
What are some complications of sickle cell anemia? & what are the interventions?
HD CA AE I
- 1. They're on lifelong abx (for infxn) - pt. education
- 2. Open area of legs that will not heal - prevention & aggressive rx of infxn
- 3. Liver dz, kidney dz (d/t decreased blood flows) - transfusion therapy
- 4. Damaged spleen (RBCs undergo massive hemolysis in spleen)
- 5. Occlusion, PAIN -pain management, organ damage (d/t SICKLED & stiff RBCs plugging the microvasculature) - stem cell transplantation
Can death be resulted from polycythemia? If so, describe the process of how this condition can lead to death.
Poly --> too much RBCs, (sometimes WBCs, platelets)--> hypercoagulable state --> clotting, stroke (d/t unhealthy platelets)
What are the primary causes of polycythemia verA?
- 1. Bone marrow d.o
- 2. Jewish males of European descent
What are the secondary causes for polycythemia?
- 1. Hypoxia - COPD, renal cancer, smoking, high altitutde
- 2. Physiologic responses to chronic hypoxia
What are the CM for polycythemia? (8)
- 1. HTN
- 2. headache
- 3. plethora - red bright cheeks
- 4. paresthesias
- 5. pruritis (liver damage?)
- 6. SPLENOMEGALY (b/c try to get rid of excessive RBC)
- 7. Thrombus formation
- 8. Visual distrubances
Should a polycythemic pt. takes oral supplements, or folic acid supplements?
NOOOO.... THEY ALREADY HAVE TOO MUCH RBCS!
1. What is the administration time for blood infusion?
2. After removal from blood bank, what is the time frame to administer blood?
3. When should you change blood tubing?
4. Should you leave a pt. w/ blood transfusion while blood is infusing?
- 1. 2 to 4 hrs
- 2. Within 30 min.
- 3. after 2 units, unless kinks or troubles in tubings.
- 4. NO. Initiate blood slowly for 15 min, be there to increase flow rate as tolerated
Pt. is getting blood infusion. Suddenly, she develops a fever, chills, low back pain, nausea, CHEST TIGHTNESS, & anxiety.
What are you suspecting & what should you do?
Acute hemolytic RXN.
DISCONTINUE IMMEDIATELY & infuse NS thru new tubing
What is the name of the test for leukemia?
What are 2 types of leukemia?
- 1. ALL: acute lymphcytic leukemia
- 2. Meylogenous (nonlympholytic) - poor prognosis
CHRONIC LYMPHOLYTIC & MYELOGENOUS
Leukemic pts are vulnerable to what type of conditions?
Infection & anemia (secondary to bone marrow destruction)
What happens when WBCs are not functional in leukemia?
Invade & destroy bone marrow, spleen, liver, lymph nodes, testes, & brain
What is the exact cause of leukemia & what is the goal rx?
- Unknown. Could be d/t chemo & radiation (decrease bone marrows), genetic, radiation & environment, immunosuppressive therapy
- Goal is to get rid of all leukemic cells
How do you treat acute & chronic leukemia?
Acute rx: 3 phases of chemotherapy
Chronic: drugs & bone marrow transplant
What is lymphoma?
- *Transformation & excess formation of lymphocytes. *Usually solid tumors that metastasize to almost any organ.
- *Typically orginiate in lymph nodes (function of fighting viral & bacterial infections)
What are the causes of Hodgkins lymphoma?
viral infection & chemical exposure
The pt. is diagnosed with HL. In the lymph node biopsy, the result shows _______
present of Reed Sternberg cells
What is the rx for HL?
CHEMO & XRT
Pt presents bone pain, joint swelling, enlarged liver & spleen, weight loss, fever, poor wound healing, anemia signs, bleeding signs.. what hematologic d.o r u suspecting?
What types of hematologic d.os would you expect pts to be in neutropenic precautions? Can pt. eat yogurt if they're on neutropenic precautions?
1. Leukemia & lymphoma.
2. No they can't! b/c of fermentation of yogurt
What is the acquired thrombyctopenia that is caused by sepsis?
What are the CM of thrombocytopenia?
- 1. Clusters of petechiae
- 2. Bruising
- 3. Ecchymosis
- 4. Purpura
What are Rx for thrombocytopenia?
- 1. Withdraw the offending drugs
- 2. Rx underlying cause - anemia, virus, leukemia, nutritional deficiency, radiation
- 3. Steroids to increase production, folate to stimulate bone marrow production, & calcium & vitamin K to stimulate clotting
- 4. Platelet transfusion
- 5. Splenectomy
What are the 3 things to do for fractures?
What is the rx for fat emboli syndrome?
No rx, just nonsurgical interventions:
- *bed rest
- *gentle handling
- *steroid therapy (for inflammationn)
- *fracture immobilization
What are some complications after a closed fractures of pelvis or long bones?
- * shock
- * fat emboli
- * ischemic necrosis
- * acute compartment syndrome
- * infection
What is a rx for acs (a complication of fractures)?
*EMERGENCY : 4-6 HRS OR IT'LL LEAD TO NEUROLOGICAL DAMAGE